Changing Trends in Microbiological and Antibiogram Profile of Bacterial Bloodstream Infection in Neonates: A Retrospective Descriptive Study

Abstract

Background

Sepsis is a major contributor to neonatal mortality. The emergence of multidrug-resistant bacteria poses difficulty in choosing empirical antibiotics. This study aimed to determine the microbiological profile and antibiotic sensitivity pattern of neonatal sepsis.

Material and Methods

This retrospective descriptive study was done in a level III neonatal unit in South India, from January 2013 to June 2020. Neonates with a single known pathogenic organism in blood culture were included. The following data were collected: demographic details, change in microbial profile and antibiotic sensitivity pattern over time, and incidence of multidrug resistance (MDR) with resistance to any three antibiotic classes.

Results

There were 228 neonates with 258 blood culture-positive bacterial sepsis. Among all neonatal intensive care unit admissions, 13.7% of neonates had culture-positive sepsis, with late-onset sepsis being predominant (72%). The most common organism was Klebsiella species (25.6%), followed by coagulase-negative staphylococcus (21.6%). The gram-negative bacteria showed the highest sensitivity to colistin (95%). All gram-positive bacteria were susceptible to vancomycin and linezolid. Prolonged empirical use of amikacin and/or ciprofloxacin as first-line antibiotics diminished microbes’ sensitivity to its action, which improved once they were discontinued as first-line drugs. MDR was seen in 47.8% and 39.2% of gram-negative and gram-positive organisms, respectively. MDR was highest among Enterobacter species (68.4%). Klebsiella species had the highest incidence of resistance due to extended-spectrum beta-lactamases (21.7%) and Amp-C (3.7%). Carbapenem resistance was seen in 22.5% of Acinetobacter species.

Conclusion

This study identified temporal changes in microbial patterns and antibiotic sensitivity. There is an increase in resistance to first-line antibiotics along with the emergence of multidrug-resistant strains. Continuous surveillance of antibiotic sensitivity patterns and periodic revision of empirical antibiotics are needed to combat sepsis in neonates.